Healthcare Provider Details

I. General information

NPI: 1700869682
Provider Name (Legal Business Name): NOVA DENTAL EAST SUBURBAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 FOREST HILLS PLAZA
PITTSBURGH PA
15221
US

IV. Provider business mailing address

215 FOREST HILLS PLAZA
PITTSBURGH PA
15221
US

V. Phone/Fax

Practice location:
  • Phone: 412-824-8830
  • Fax: 412-824-0493
Mailing address:
  • Phone: 412-824-8830
  • Fax: 412-824-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS019606L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS026612L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS025542L
License Number StatePA

VIII. Authorized Official

Name: DR. BARRETT M BENDER
Title or Position: DENTIST OWNER
Credential: DMD
Phone: 412-824-8830